Healthcare Provider Details

I. General information

NPI: 1033367230
Provider Name (Legal Business Name): 60003 DB HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10046 NORTH METRO PARKWAY WEST SUITE 115
PHOENIX AZ
85051-1411
US

IV. Provider business mailing address

PO BOX 2954
PHOENIX AZ
85062-2954
US

V. Phone/Fax

Practice location:
  • Phone: 602-674-5515
  • Fax:
Mailing address:
  • Phone: 602-674-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number7850
License Number StateAZ

VIII. Authorized Official

Name: DR. DANIEL EDWARD BRUNKHORST
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 602-674-5515